Fertility: A Novel (24 page)

Jeff had the OR nurse call Sarah’s family to let them know he’d be ready to meet with them around half past eleven. When neither number answered he surmised they were with Sarah’s baby, and unable to use their phones in the NICU. A call there proved him right, and the nurse relayed the message.

Jeff willed himself to appear authoritative as he walked through the door to the surgical waiting room a few minutes past the appointed time. The lights had been dimmed low and the coffee pot cleaned out for the day. The receptionist was long gone when Jeff approached the only two people left in the room. They sat holding hands on the sofa in front of a television tuned to David Letterman. Jeff wasn’t sure, but they might have been dozing. They startled when he approached.

“Excuse me, are you the parents of Sarah Abadhi?”

Eva and Joseph struggled to rouse themselves. They both pushed off from the sofa at the same moment, still holding hands.

“Please, sit down. I would actually like to sit down, if that’s all right with you. It’s been a long day for me — and I assume for the both of you.”

Eva muted the TV with the remote and Jeff pulled up an armchair so he could sit facing the exhausted mother and father. The parents and the surgeon took the measure of one another. Even in the low light, Jeff immediately saw the resemblance between Sarah and her dad.

“I’m Dr. Gotbaum,” he said, extending his hand to them both.

“Thank you, Doctor, for coming to talk with us at this late hour. We’re eager to hear how our daughter is doing,” Eva said.

“Well, she’s been through a lot, but she’s stable and doing well in recovery. Apparently the only serious injury she sustained was to her leg. Dr. Hanna, who delivered your granddaughter, said the C-section was uneventful. Did you get a chance to talk with her?”

“No, we didn’t,” Joseph said.

“Well,” the orthopedic surgeon continued, “there appear to be no internal injuries to your daughter’s vital organs. In that sense she was very lucky, given the magnitude of the accident she was involved in.”

Joseph bristled at the thought. “Lucky wouldn’t be a word I would apply to what happened to our daughter today, but I take your meaning.”

“We’re lucky in another sense,” Eva said, trying to soften Joseph’s rebuke to the doctor. “We’ve seen our granddaughter and she’s beautiful. Dr. Feinberg, the neonatologist, says she appears to be responding like a normal newborn. We’re so thankful for that. The doctor said Sarah told you the baby’s name? She’d kept the names to herself throughout her pregnancy.”

“While she was still in the ER she made me promise to hold the baby when it was born and call it Anna if it was a girl.”

Joseph got a quizzical look on his face.

“I should explain that Sarah and I are acquaintances. She’s a friend of a friend and we’ve gone running together a few times in the past. So we were both surprised to see one another in the ER. She wanted to be able to hold the baby after it was born, but Dr. Hanna and I thought it best to go with general anesthesia. That meant Sarah would be asleep when the baby was born, hence my offer to hold the baby and welcome it to the world.”

Immediately Eva started wondering if this Dr. Gotbaum might be more than a friend of a friend. Was it possible that he was the father of her little granddaughter? “Dr. Gotbaum, so you held little Anna first? That was so kind of you. You’ll have to tell Sarah when you see her tomorrow.”

Generally Joseph enjoyed Eva’s ability to make light conversation with anyone under any circumstance, but not tonight. “Yes, that was very thoughtful of you, Dr. Gotbaum, but could we get back to the extent of Sarah’s injuries? What exactly happened to Sarah’s leg?” There was impatience in his voice. Jeff, who had started to relax, felt his muscles tense up again.

“Certainly, Mr. Abadhi. Apparently Sarah’s leg was struck by a steel construction stud. My best guess is that it hit the ground and then bounced up, striking her lower right leg with great energy. It caused significant trauma. Both the tibia and fibula were broken in a number of places. In addition, the bone fragments punctured the skin, making what we call an open, multifragmentary fracture. There was also significant contamination by construction debris.”

Joseph’s jaw clenched as he listened to the description of his daughter’s injuries. He squeezed Eva’s hand so hard it hurt, but she didn’t pull away. “So what can be done to undo so much damage?” he asked.

“First we irrigated aggressively to clean out the surgical sites. We followed that with debridement of the contaminated tissue to try to ward off infection, which is always a possible complication in cases such as this. Then Dr. Lewis, a vascular surgeon, repaired the damage to the leg’s circulatory system. There were some soft-tissue injuries. I repaired those and restored the fractured pieces of bone to their proper positions. I also removed several small bone fragments that would cause trouble later on in the healing process. I decided to do an external fixation of the fractures because of the extent of the injuries and the debris that had entered through the openings to Sarah’s skin. Are either of you familiar with external fixation?” Jeff asked, hoping he wouldn’t have to go into an extensive description of the repair needed for grade III fractures with contamination and soft-tissue damage.

Joseph and Eva looked at one another and shook their heads. “No, we don’t know what that is,” Joseph said. “Please, explain what it means.”

“Well, you’re probably most familiar with casts for immobilizing fractures of the bone. But in this case, a cast wouldn’t allow us to care for the wounds to soft tissue. We have to be able to get in and clean out the area of the injury for the next several days. Another alternative is internal fixation, where I would nail, screw or wire together the pieces of broken bone. But given the contamination by the construction debris, I felt that would open Sarah up to an increased risk of infection — and possibly the loss of the leg.”

Eva gasped. “Oh my god. Amputation? I had no idea.” She thought she might throw up the sandwich Joseph had encouraged her to eat.

“In an injury this severe, amputation can never be entirely ruled out. My approach to the repair was to bring that possibility to a minimum.”

“So please, Doctor, explain this external fixation,” Joseph pressed.

“I inserted pins through the skin and into the bones to hold them in the correct position. The pins are held in place by an external frame — hence the name ‘external fixation,’” Jeff explained. “This type of fixation works best in superficial bones such as those in the lower leg, where the chance of pin-tract infection is minimal.”

“I don’t believe I’ve ever seen this, but I’m with you so far. Please go on,” Joseph urged.

“This method allows us to watch the status of the wound sites and continue irrigation and debridement until we’re certain the risk of infection has passed. The advantage of this type of rigid fixation is that it lets us aggressively and simultaneously treat both Sarah’s fractures and her soft-tissue injuries. It also allows us to have her moving her ankle and knee joints, which is good for edema reduction and the general health of her muscles and joints. We can also elevate her leg without any pressure on the injured soft tissues at the back of her leg. We’re actually able to suspend her leg — thus keeping down swelling — by attaching ropes from the overhead frame on her bed to the external frame surrounding her lower leg. We can also get Sarah up and about earlier — with a walker or crutches — without fear of destabilizing the fracture.”

“What does this thing look like, Dr. Gotbaum?” Joseph inquired, genuinely curious.

“I won’t lie to you. It’s a little strange at first glance. It’s a round, metal frame that goes entirely around Sarah’s leg from her knee to her ankle. The pins go out from her leg bones to the frame. Strange as it looks, it’s actually an ingenious invention that’s become standard procedure for injuries such as Sarah’s. Compared with other types of fixation, the research shows it leads to the best outcomes.”

“So you think she’ll be all right?” Eva asked hopefully.

This was the question Jeff dreaded. Everyone wanted to be given a worry-free prognosis. He’d try his best. “I don’t want to minimize the seriousness of the injury Sarah sustained. But she has many factors in her favor: She’s young and otherwise healthy, she’s had good nutrition and she’s not a smoker. Nicotine impairs bone healing. She’s not diabetic, and that’s great because elevated blood sugar levels also impede healing. The fact that a single limb was involved and that her joints — the knee and ankle in this case — were not affected are all things in her favor.”

“What are you saying, Dr. Gotbaum?” Eva asked. “What’s not in her favor?”

“My biggest concerns now are infection and whether the healing of the bone will proceed and allow restoration of good function. To help her recovery along, we’ll start Sarah on physical therapy. Getting her to move — even in bed — will start tomorrow. She won’t be able to put any weight on the leg for some time, but since she’s so fit, I think the therapists will actually be able to get her out of bed in a day or two.”

Eva mustered the courage to ask the sixty-four-thousand-dollar question. “What if things don’t go as you hope? What if she gets an infection or the bones don’t heal well?” Joseph’s face twitched as he awaited the doctor’s reply.

“Bone healing is a remarkable process. In most cases the strength of a healing bone is eighty percent of normal three months after an injury. But the next days and weeks will be critical. Should infection set in, we can fight it with IV antibiotics. We’ve already got her on a prophylactic antibiotic regimen. Other complications could be nerve damage or poor bone healing. And of course, the worst-case outcome would be failures so severe that amputation would have to be considered.”

“What type of odds are we talking about?” Joseph asked.

Jeff swallowed hard. “Complications during the healing process can occur in as many as fifty-five percent of cases such as Sarah’s. Most of the time, we can address them, either medically or surgically. But there are cases where all our efforts fail and the only option is to remove the leg.” Jeff stopped there to gauge the parents’ response. They both looked horrified, as was Jeff when he tried to imagine Sarah as an amputee. Now that he had laid out the worst-case scenario he tried to give them some reason for optimism. “While amputation is not out of the realm of possibility, it’s my hope that Sarah will make a good recovery because of all the factors I’ve already mentioned. She’s a motivated, bright, healthy patient. I think it’s not unrealistic to hope for a good outcome.”

“Not unrealistic?” Joseph said. “Well, for Sarah’s sake, I hope you’re right.”

* * *

Jeff skipped dictating his op-notes and headed home right after saying good-bye to the Abadhis. He felt like crap. According to the OR nurses, the casualty count from the crane accident was mounting. To add insult to injury, the weather was more like Alaska than New York. By the time he entered his lobby, he couldn’t feel his toes.

Now he’d have to cap off the miserable day by telling Rick about Sarah — and her baby. He worried about how Rick would take it. He’d started to come around over the last few months, drinking less, working out again, eating better. Jeff figured he still had it bad for Sarah, but he was getting by, making do — like the rest of the poor, single
schmucks
he knew. Jeff wondered if the news might undo him. He prayed Rick was asleep so he could put off telling him until morning.

As he turned the key in the door he could hear the TV. Shit. Rick was up, probably watching a game.

“Hey bro, long day,” Rick said, without looking up from the screen.

“Yeah. You probably heard about the crane accident. I caught an open, multifragmentary fracture and it was a beast.”

“Yeah, heard about the accident,” Rick said distractedly, with his attention still fixed on Kobe Bryant, who was on a scoring roll. “The city is becoming a dangerous place. Remind me not to walk under any cranes.”

Jeff went into the kitchen and remembered he hadn’t had any lunch or dinner. He opened the fridge and took out some leftover Chinese, set the microwave for two minutes and opened a beer.

“Who’s winning?” Jeff called out to the living room, hoping to buy some time.

“The Lakers, 101 to 83 with a minute left on the clock. Kobe’s amazing tonight. Nothing unusual about that,” Rick said, more to himself than to Jeff.

When the microwave timer went off, Jeff got his moo shu and took it into the living room. Rick moved over to make room for him on the sofa.

“Aren’t you on tomorrow?” Jeff asked.

“I couldn’t sleep so I thought I’d watch a game. It’s working. I’m beat now.”

“Well, I’m beyond beat. This is my first meal since breakfast. And I’ve been on my feet most of the day.”

“You surgeons have it so rough,” Rick mocked. “But you also make the big bucks.” Then he jabbed his fingers into Jeff’s ribs.

“Hey, watch it! I’m in no mood for your razzing. If you’d get serious for a minute I want to talk to you about something.”

“Sorry, brother. What’s going on?”

“The surgery I just finished — the open, multifragmentary fracture — I was operating on Sarah Abadhi.”

Rick felt his face grow hot. Though it had been over seven months, Sarah still had possession of the prime real estate in his head. Other women he had considered since they split — women who once would have made him perfectly happy — didn’t measure up. Hard as he tried, he couldn’t stop comparing them to her.

“What do you mean? Don’t tell me she was involved in that crane accident.”

“I’m sorry, Rick. She was. I’m so sorry.”

Rick swallowed hard. “How bad is it?”

“Her right lower leg took a direct hit. She suffered a very nasty trauma. I was in the OR with her for nearly six hours.”

“How did the surgery go?” Rick asked in a voice so low Jeff had to strain to hear him.

“Well, that’s the thing. I pulled out all the stops, but I’m not certain it’s going to work. It may, but I have to be honest. I’m not as sure as I’d like to be.”